Guide to the Basics of Bipolar Disorder

Demystifying a Complex and Often Confusing Illness

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Bipolar disorder is a type of mental illness that is as frightening to some as it is confusing. It is important to couch the disorder in the most fundamental terms to better understand what it is, how it is diagnosed, and what you can do to treat it.

Overview of Bipolar Disorder

Bipolar disorder is characterized by swings in emotion which we refer to as "cycles." These cycles can sometimes cause extreme upswings in emotion (called mania) interspersed with extreme downswings (called depression).

This is why the condition was once called manic-depression.

Bipolar disorder can vary enormously from one person to the next, both in terms of the type and severity of behaviors. In the end, the one thing that characterizes bipolar disorder is that the emotional cycles affect a person’s ability to function on a day-to-day basis.

Fortunately, there are now therapies that can help people manage their disorder.

Features of Bipolar Disorder

The two main features of bipolar disorder are mania and depression which we describe as "moods." The period of a manic and depressive behavior is similarly described as a "mood episode."

The moods associated with bipolar disorder can be broadly classified as follows:

  • Bipolar mania is characterized by sustained periods of abnormally elevated mood and other behaviors considered extreme or exaggerated. The features can vary from person to person and last anywhere from a few days to several months.
  • Bipolar depression has all of the features of classic depression with one main difference: it is associated episodic cycles of mania and depression.
  • Hypomania an intermediate mood that we sometimes think of as "mania light." It tends to be shorter lasting and less severe than mania but may cycle with severe episodes of depression.

    While neither mania nor depression should be considered a psychosis (a break from reality), psychosis can, in fact, be a feature of bipolar disorder. If may be a temporary condition in some, a long-lasting one in others, and a non-entity in most.

    Types of Bipolar Disorder

    In the same way that the features of bipolar disorder can vary, so, too, can the cycle and severity of mood episode. From a broad perspective, we can divide bipolar disorder into the four distinct categories:

    We can also characterize bipolar disorder by the speed by which mood episodes change. One such condition is called rapid bipolar disorder in which there are four or more mood episodes per year.  If there are four or more mood episodes per month, we refer to that as the ultra-rapid bipolar disorder.

    Diagnosis of Bipolar Disorder

    The diagnosis of bipolar disorder is based on a prolonged mood episode (or episodes) that interferes with a person’s ability to function.

    To make the diagnosis, all other causes must first be ruled out, including recent trauma, pregnancy, drug or alcohol use, anxiety disorders, panic attacks, neurological disorders, and other illnesses.

    Doctors can make a diagnosis based on a review of symptoms outlined in American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. The presence of at least three (and ideally more) symptoms in generally indicative of bipolar disorder.

    Treatment of Bipolar Disorder

    Treatment can vary based on the type and severity of mood episodes. Medication treatments can include:

    • Mood stabilizers, including anticonvulsants and benzodiazepines, that help control the highs and lows of bipolar disorder.
    • Antidepressants to treat episodes of bipolar depression (although they are used less commonly these days).
    • Antipsychotics for people who lose touch with reality during a manic or depressive episode.

    But ultimately, medication alone cannot treat bipolar disorder. Psychotherapy is a key component can include cognitive behavioral therapy (CBT), family-focused therapy, and group therapy. A healthy diet, plenty of rest, avoidance of alcohol, regular exercise, and a strong social network are also associated with better health outcomes.

    Persons with persistent or severe mood episodes may benefit from electroconvulsive therapy (ECT), particularly if there experiencing suicidal thoughts.


    • National Institute of Mental Health: National Institutes of Health. "Bipolar Disorder." Bethesda, Maryland; updated April 2016.